Clinical Nutrition ESPEN xxx (2017) e1ee6

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Clinical Nutrition ESPEN

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Original article

Chilli intake is inversely associated with hypertension among adults

Zumin Shi a, b, c, *, Malcolm Riley d, Alex Brown a, c, Amanda Page a, b
a
South Australia Health and Medical Research Institute, Adelaide, Australia
b
Adelaide Medical School, University of Adelaide, Adelaide, Australia
c
University of South Australia, Adelaide, Australia
d
Commonwealth Scientific and Industrial Research Organisation (CSIRO), P.O. Box 10041, Adelaide, South Australia 5000, Australia

a r t i c l e i n f o s u m m a r y

Article history: Background & aims: This study aimed to examine the association between chilli intake and the incidence
Received 6 December 2017 of hypertension in a Chinese adult population.
Accepted 7 December 2017 Methods: Adults aged 20e75 years in the China Health and Nutrition Survey were followed from 1991 to
2011. Dietary data were collected during home visits using a 3-day food record in 1991, 1993, 1997, 2000,
Keywords: 2004, 2006, 2009 and 2011. Cox regression was used in the analysis. Blood pressure was measured at
Chilli intake
each data collection point.
Hypertension
Results: 13,670 adults were followed for a median of 9.0 years. During 132,089 person years of follow-
Cohort study
up 4040 subjects developed hypertension. Chilli consumption was inversely associated with the
incidence of hypertension. The incidence rate of hypertension was 30.5, 33.4, 31.9, and 24.0 per 1000
person years among those who consumed no chilli or 1e20, 20.1e50,
50.1 g/day respectively.
Adjusting for age, gender, energy intake, sodium and fat intake, smoking, alcohol consumption and
physical activity, those with increasing cumulative average chilli intake were less likely to develop
hypertension: 0, 1e20, 20.1e50 and
50.1 g/day had a hazard ratio (HR) for hypertension of 1.00, 0.80
(95%CI 0.73e0.88), 0.81 (0.73e0.89) and 0.65 (0.57e0.75) (p for trend <0.001) respectively. The as-
sociation was independent of overall dietary patterns and BMI. There was no significant interaction
between chilli intake and gender, income, education and residence (urban/rural) in relation to the risk
of hypertension.
Conclusions: Chilli intake is inversely associated with the risk of developing hypertension in Chinese
adults.
© 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights
reserved.

Hypertension is one of the leading preventable risk factors for
premature mortality in the Chinese population [1], similar to many
other populations across the world. Data from the 2002 Chinese
National Nutrition Survey indicate that one in six adults are hy-
pertensive [2]. Only 19% of those with hypertension have adequate
blood pressure control [2]. Sodium intake increases the risk of hy-
pertension in the Chinese population [3], however, other dietary
factors have also been found to be associated with hypertension [4].
Chilli is one of the most commonly used spices [5] in the world
with a substantial geographical variation in intake (e.g. the actual
chilli intake (grams/day) is higher in Asia than Europe [6]). About
a third of adults in China consume spicy food, including chilli,
daily [7].
* Corresponding author. South Australia Medical and Health Research Institute,
Level 4, SAHMRI, North Terrace, Adelaide, 5000, Australia. Fax: þ61 8 8313 1228.
E-mail address: Zumin.shi@adelaide.edu.au (Z. Shi).
Chilli and its active component capsaicin have been reported to
have a range of health benefits including reducing obesity [8] and
rhinitis [9], and increasing muscle strength [10]. Recently, two large
population studies in China and the USA found that chilli con-
sumers had a lower risk of mortality compared with non-
consumers [7,11].
Evidence from animal studies suggest that capsaicin may pre-
vent hypertension and cardiovascular disease via activation of the
ion channel transient receptor potential vanilloid subtype 1
(TRPV1). Activation of TRPV1 has been shown to inhibit vascular
oxidative stress [12], increase urinary sodium excretion [12] and
increase the production of nitric oxide [13]. In addition, activation
of TRPV1 has been shown to blunt cardiac hypertrophy and fibrosis
[14]. Further, capsaicin supplementation reduced diet-induced
hypertriglyceridemia in rodents [15]. Capsaicin has also been
shown to have beneficial effects in animal models of disease. For

https://doi.org/10.1016/j.clnesp.2017.12.007
2405-4577/© 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Please cite this article in press as: Shi Z, et al., Chilli intake is inversely associated with hypertension among adults, Clinical Nutrition ESPEN
(2017), https://doi.org/10.1016/j.clnesp.2017.12.007
e2 Z. Shi et al. / Clinical Nutrition ESPEN xxx (2017) e1ee6
example, in diabetic mice capsaicin suppresses vascular oxidative
stress and improves endothelium-dependent relaxation [16]. In a
small clinical trial (n ¼ 84), it has been shown that administration
of capsaicin and isoflavone reduces blood pressure in hypertensive,
but not normotensive, human subjects. This is thought to occur via
increasing serum levels of insulin-like growth factor-1 (IGF-I) [17].
The association between chilli consumption, hypertension and
cardiovascular disease (CVD) has not been well studied in large
population based observational studies [12]. Therefore, it is un-
known whether the findings from the animal studies and short
term clinical trials can be translated to the general population.
Using data from the China Health and Nutrition Survey (CHNS), we
have recently found chilli intake was associated with a reduced risk
of developing overweight/obesity [18]. As obesity is an important
risk factor for hypertension, it can be hypothesized that chilli intake
may either directly or indirectly reduce the risk of hypertension.
Using data from the CHNS, we aimed to assess the association
between chilli consumption and the incidence of hypertension in a
Chinese adult population.
1. Methods
1.1. Study sample
The CHNS study is a household based study and uses a multi-
stage random-cluster sampling process to select a sample in both
urban and rural areas in nine provinces in China. Nine waves of data
collection (i.e. 1989, 1991, 1993, 1997, 2000, 2004, 2006, 2009, and
2011) have been conducted [19,20]. All the members in the selected
households were invited to participate in the study, however di-
etary intake measurement in 1989 only involved middle aged
adults. Due to rural migration and city construction, loss to follow-
up is high but new households in the same community joined the
survey as a replenishment sample for those lost to follow-up since
1997. The response rate based on those who participated in 1989
and remained in the 2006 survey was above 60%. The survey was
approved by the institutional review committees of the University
of North Carolina (USA) and the National Institute of Nutrition and
Food Safety (China). Informed consent was obtained from all par-
ticipants. Between the 1991 and the 2011 survey, there were 29,220
participants aged 20 years and older. We excluded those without a
dietary intake measurement (n ¼ 13,793), those who had an
implausible estimated daily energy intake (men: >6000 kcal or
<800 kcal; women: >4000 or <600 kcal) (n ¼ 651), pregnant
women or those breastfeeding (n ¼ 798), or individuals with an
implausible BMI (<14 or >45 kg/m2, n ¼ 38), or aged>75 years
(n ¼ 2202) during a survey year (otherwise included during other
survey years). In total, 18,611 individuals participated in at least two
waves of data collection and had an estimated chilli intake. After
excluding those that were hypertensive at baseline (n ¼ 4815),
13,670 participants were included in the final analysis.
1.2. Outcome variable: hypertension
Blood pressure was measured three times on the right arm in
sitting position using a mercury sphygmomanometer after at least a
10-min rest. The mean of three readings was used in the analysis.
Hypertension was defined as systolic blood pressure above
140 mmHg and/or diastolic blood pressure above 90 mmHg, or
having known hypertension.
1.3. Exposure variables: chilli intake
Detailed description of the dietary measurement has been
published previously [19]. At each wave, all food and condiments in
Please cite this article in press as: Shi Z, et al., Chilli intake is inversely associated with hypertension among adults, Clinical Nutrition ESPEN
(2017), https://doi.org/10.1016/j.clnesp.2017.12.007
the home inventory, purchased from markets or picked from gar-
dens, and food waste, were weighed and recorded by interviewers
at the beginning and end of the three-day food consumption sur-
vey. Individual dietary intake data in each household were
collected by a trained investigator using a 24 h dietary recall on
each of 3 consecutive days. Cooking oil and condiment consump-
tion for each individual in the household was estimated using
household estimated intake weighted by individual energy intake.
The dietary assessment method has been validated for energy
intake [21]. Nutrient intake was calculated using the Chinese Food
Composition Tables.
A cumulative average intake of chilli (sweet capsicum was not
included) was calculated for each individual at each time period to
reduce variation within individuals and to represent long term
habitual intake [22]. For example, the 1991 intake was used for the
follow-up between 1991 and 1993, the cumulative average of the
1991 and 1993 intake was used for the follow-up between 1993 and
1997, the cumulative average of the 1991, 1993 and 1997 intake was
used for the follow-up between 1997 and 2001, and so on.
Habitual intake of spicy food was only asked in 2009 by the
questions “Do you like to eat hot pepper or spicy food? 1) No, 2)
Sometimes (2 times/week), 3) Often (3e4 times/week), 4) Usually
(
5 times/week), 5) Unknown”, and “What kind of spicy food do
you like? 1) A little bit hot, 2) Moderate hot, 3) Very hot, 4)
Unknown”.
1.4. Covariates
A structured questionnaire was used to collect information on
sociodemographic and lifestyle factors in each wave. The following
constructed variables were used as indicators of socioeconomic
status: education (low: illiterate/primary school; medium: junior
middle school, and high: high middle school or higher), per capita
annual family income (recoded into tertiles as low, medium and
high), urbanization levels [19] (recoded into tertiles as low, medium
and high).
Physical activity level (metabolic equivalent of task, (MET)) was
estimated based on self-reported activities (including occupational,
domestic, transportation, and leisure time physical activity) and
duration using a Compendium of Physical Activities. Smoking sta-
tus was categorized as non-smokers, ex-smokers and current
smokers. Alcohol consumption was recoded as none, 1e2 times/
week, 3e4 times/week, and daily. Height and weight were
measured at each wave. Overweight/obesity was defined as BMI

25 kg/m2.
1.5. Statistical analysis
Chilli intake was recoded into four levels: non-consumers, 1e20,
20.1e50,
50.1 g/day.
The chi square test was used to compare differences between
groups for categorical variables and one-way analysis of variance
(ANOVA) for continuous variables. We used Cox proportional haz-
ards models with time varying cumulative chilli consumption and
covariates to compute hazard ratios for hypertension. Four models
were used: model 1 adjusted for age, gender and energy intake;
model 2 further adjusted for intake of fat, smoking, alcohol con-
sumption, income, urbanization, education, and physical activity.
Model 3 further adjusted for two dietary patterns (traditional south
pattern and modern pattern, determined using factor analysis
based on our previous publication [23]). The dietary patterns were
constructed based on 35 food groups aggregated from 3-day food
records to reflect the overall dietary intake. Traditional south
pattern is characterised by a high intake of rice, pork, and vegeta-
bles, and low intake of wheat; a modern dietary pattern had a high
 Z. Shi et al. / Clinical Nutrition ESPEN xxx (2017) e1ee6 e3

intake of fruit, soy milk, egg, milk and deep fried products. Model 4
further adjusted for BMI.
Cox proportional hazards model assumptions were assessed by
visual inspection of logelog plots generated by stphplot syntax in
Stata. Multiplicative interaction between chilli intake and gender,
income, education and residence (urban/rural) was tested by add-
ing the product of the variables in the regression models.
In sensitivity analyses, we also used baseline chilli intake, or
most recent chilli intake as the exposure variable. To assess the
association between cumulative chilli intake and blood pressure
change between 1991 and 2011 among all participants (including
those who had hypertension at baseline), we used linear mixed-
effect regression adjusting for the same covariates as described
for model 4 above. Cross-sectional association (prevalence ratio,
PR) between frequency of spicy food intake and preference for hot
chilli and hypertension in 2009 was assessed using Poisson
regression with robust standard errors. The association between
frequency of spicy food intake as well as preference for hot chilli
and salt/sodium intake was assessed using linear regression. All the
analyses were performed using STATA 15.1 (Stata Corporation,
College Station). Statistical significance was considered when
p < 0.05 (two sided).
2. Results
At baseline, participants with a high chilli consumption had a
lower income and BMI, and were more physically active compared
with non-consumers (Table 1). Energy and sodium intake were
positively associated with chilli consumption. Traditional and
modern dietary pattern was positively and inversely associated
with chilli consumption respectively. At all data collection waves,
the mean intake of chilli was about 15 g/day after adjusting for age
and gender. The median portion size for chilli intake was 50 g. In
each survey, around 30% of the participants consumed chilli during
the 3 days of measurement. Among the chilli consumers about 30%
had an estimated chilli intake above 50 g/day (data not shown).
There was a positive association between chilli intake and energy
intake among chilli consumers (correlation coefficient 0.12,
p < 0.001). Cumulative chilli intake was positively associated with
self-reported frequency intake and the preference for hot chilli in
2009 (data not shown).
Overall, 13,670 adults were followed for a median of 9.0 years.
During 132,089 person years of follow-up, 4040 subjects devel-
oped hypertension. Chilli consumption was inversely associated
with the incidence of hypertension. The incidence of hypertension
was 30.5, 33.4, 31.9, and 24.0 per 1000 person years among those
with cumulative average chilli consumption of 0, 1e20, 20e50,
>50 g/day respectively (Table 2). After adjusting for age, gender,
energy, sodium and fat intake, smoking, alcohol consumption and
physical activity, those who ate chilli 0, 1e20, 20e50 and >50 g/
day had a hazard ratio (HR) for hypertension of 1.00, 0.80 (95%CI
0.73e0.88), 0.81 (0.73e0.89) and 0.65 (0.57e0.75) respectively (p
for trend <0.001). After further adjusting for overall dietary pat-
terns or BMI, the association was slightly attenuated but remained
statistically significant. There was a significant inverse association
between baseline chilli consumption or most recent chilli con-
sumption and incidence of hypertension. There was no interaction
between cumulative average chilli intake and gender, income,
education and residence (urban/rural) in relation to the risk of
hypertension.

Table 1
Baseline sample characteristics by baseline chilli intake categories (n ¼ 13,670).

Factor None 1e20 g/day 20.1e50 g/day
50.1 g/day p-value

N 9732 1119 1433 1386

Energy intake (kcal/d), mean (SD) 2429.5 (692.2) 2382.8 (698.0) 2475.9 (705.0) 2752.1 (748.5) <0.001
Fat intake (g/day), mean (SD) 64.9 (36.2) 67.7 (36.3) 70.1 (40.6) 68.5 (43.8) <0.001
Protein intake (g/day), mean (SD) 72.7 (23.4) 72.5 (23.8) 73.0 (23.1) 79.7 (26.0) <0.001
Carbohydrate intake (g/day), mean (SD) 384.3 (138.0) 364.4 (136.3) 381.5 (132.7) 449.0 (149.7) <0.001
Sodium intake (g/day), mean (SD) 6.2 (5.5) 5.9 (4.9) 6.5 (5.9) 7.0 (5.5) <0.001
Traditional dietary pattern score 0.1 (1.1) 0.1 (1.0) 0.2 (0.9) 0.3 (1.1) <0.001
Modern dietary pattern score 0.2 (0.9) 0.1 (1.0) 0.3 (0.9) 0.6 (0.8) <0.001
Age (years), mean (SD) 39.5 (14.5) 37.9 (13.8) 38.6 (13.9) 38.3 (13.6) <0.001
BMI (kg/m2), mean (SD) 22.0 (3.0) 22.0 (3.0) 21.8 (2.8) 21.6 (2.6) <0.001
BMI status (%) <0.001
Underweight 8.6% 9.0% 8.7% 9.3%
Normal 75.8% 75.3% 76.5% 81.1%
Overweight 14.2% 14.5% 14.0% 8.9%
Obese 1.4% 1.2% 0.8% 0.8%
Sex (%) 0.014
Men 48.2% 48.4% 49.8% 52.7%
Women 51.8% 51.6% 50.2% 47.3%
Income (%) <0.001
Low 29.3% 28.3% 28.7% 36.3%
Medium 32.7% 31.2% 31.5% 34.9%
High 38.0% 40.5% 39.7% 28.9%
Education (%) <0.001
Low 44.6% 40.3% 41.1% 52.2%
Medium 34.0% 30.1% 34.0% 29.6%
High 21.5% 29.6% 24.9% 18.2%
Urbanization (%) <0.001
Low 41.2% 31.6% 35.8% 49.9%
Medium 28.8% 32.9% 33.0% 29.5%
High 30.0% 35.5% 31.2% 20.6%
Smoking (%) <0.001
Non smoker 67.1% 65.9% 62.4% 64.6%
Ex-smokers 1.6% 1.5% 1.2% 2.6%
Current smokers 31.3% 32.6% 36.3% 32.8%
Physical activity (MET-hrs/week), mean (SD) 203.5 (172.4) 197.5 (168.5) 207.6 (188.3) 213.5 (174.6) 0.11

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Table 2
Hazard ratio (95%CI) for incident hypertension by chilli intake levels.

Chili intake (g/day)

None 1e20 20.1e50
50.1 p for trend

A. Cumulative average chilli intake

Cases 2220 823 678 319
Person-years 72,906 24,671 21,246 13,267
Incident rate (per 1000) 30.5 33.4 31.9 24.0
Model 1 1.00 0.80 (0.74e0.87) 0.81 (0.74e0.88) 0.68 (0.60e0.77) <0.001
Model 2 1.00 0.80 (0.73e0.88) 0.81 (0.73e0.89) 0.65 (0.57e0.75) <0.001
Model 3 1.00 0.80 (0.73e0.87) 0.83 (0.75e0.91) 0.69 (0.61e0.79) <0.001
Model 4 1.00 0.78 (0.71e0.86) 0.84 (0.76e0.92) 0.72 (0.63e0.82) <0.001
B. Baseline chilli intake
Cases 2902 280 449 409
Person-years 92,885 10,144 13,567 15,494
Incident rate (per 1000) 31.2 27.6 33.1 26.4
Model 1 1.00 0.89 (0.79e1.01) 1.06 (0.96e1.17) 0.76 (0.69e0.84) <0.001
Model 2 1.00 0.92 (0.80e1.05) 1.06 (0.95e1.19) 0.76 (0.67e0.85) <0.001
Model 3 1.00 0.92 (0.80e1.05) 1.08 (0.97e1.21) 0.79 (0.70e0.88) 0.003
Model 4 1.00 0.92 (0.81e1.06) 1.10 (0.98e1.23) 0.82 (0.72e0.92) 0.019
C. Most recent chilli intake
Cases 2883 322 459 376
Person-years 91,950 10,986 14,758 14,395
Incident rate (per 1000) 31.4 29.3 31.1 26.1
Model 1 1.00 0.85 (0.76e0.96) 0.92 (0.84e1.02) 0.80 (0.72e0.89) 0.001
Model 2 1.00 0.86 (0.76e0.98) 0.93 (0.84e1.04) 0.80 (0.71e0.90) 0.001
Model 3 1.00 0.87 (0.77e0.99) 0.96 (0.86e1.07) 0.84 (0.74e0.94) 0.014
Model 4 1.00 0.89 (0.79e1.01) 0.96 (0.86e1.07) 0.85 (0.75e0.96) 0.022

Model 1 adjusted for age, gender and energy intake.

Model 2 further adjusted for intake of fat and sodium, smoking, alcohol drinking, income, urban, education, and physical activity.
Model 3 further adjusted for dietary patterns.
Model 4 further adjusted for BMI.
All the adjusted variables are treated as time-varying covariates.

About 70% of the participants reported consuming spicy food in
2009. Frequency as well as hotness of spicy food consumption was
not cross-sectionally associated with either salt or sodium intake in
2009 (data not shown). Frequency of spicy food intake was
inversely associated with hypertension (Supplement Fig. 1).
Compared with non-consumers, those reported chilli consumption
five times or more per week had a PR of 0.85 (95%CI 0.75e0.97) for
hypertension. However, there was no dose response relationship
between hotness of spicy food intake and hypertension.
High cumulative chilli intake was inversely associated with an
increase in blood pressure during follow-up (Supplement Fig. 2).
3. Discussion
In this large prospective cohort study, high intake of chilli was
inversely associated with the risk of hypertension independent of
overall dietary pattern, energy intake and lifestyle factors. This is
the first prospective study of chilli intake and the development of
hypertension using data from general population.
There is a large variation on chilli intake with a high proportion
had chilli intake
50 g daily. Chill intake in China is different from
Western/European countries both in terms of types and amounts
[24]. In Western populations, the intake of chilli is less likely to
reach 50 g/day.
Our findings on the association between chilli intake and the
risk of hypertension are supported by two recent studies on chilli
intake and mortality in China and USA [6,10]. In both of these
studies it was suggested that chilli consumption reduced the risk of
mortality [6,10]. These observations are also consistent with an
inverse association between chilli intake and the risk of over-
weight/obesity [18]. We previously reported that individuals with
chilli intake above 50 g/day had >25% reduced risk of developing
overweight/obesity (HR 0.73 (95%CI 0.63e0.84)) compared with
non-consumers of chilli in the adult population. The findings of the
inverse association between chilli intake and hypertension from
both cross-sectional and longitudinal analyses largely preclude the
possibility of reverse causation (i.e. it is unlikely that the develop-
ment of hypertension results in a higher reported intake of chilli for
any reason).
Although the exact mechanisms of the beneficial effects of chilli
on blood pressure are yet to be fully elucidated, several hypotheses
have been proposed. Firstly, it is known that overweight or obese
individuals are more likely to develop cardiovascular diseases and
hypertension [25]. Chilli intake may prevent obesity [26e28],
through increased energy expenditure and as a consequence could
have beneficial effects on the cardiovascular system. However,
adjusting for BMI did not materially change the inverse association
between chilli intake and the risk of hypertension in our study.
Secondly, the active component of chilli, capsaicin, can increase
urinary sodium excretion [12]. High sodium intake is a known risk
factor for hypertension. In China, the mean salt intake was as high
as 9 g/day in 2009e2012 [29]. In the current sample, chilli intake is
positively associated with sodium intake. Therefore, our findings
may suggest that a higher intake of chilli may mitigate the adverse
effect of salt by increased sodium excretion. Thirdly, many cross-
sectional studies have reported a relationship between physical
activity and blood pressure with low physical activity possibly
preceding hypertension onset [30]. In the current study we did not
demonstrate an association of baseline chilli intake with physical
activity although there was a strong association with increased
energy intake. In any case, adjustment for physical activity made
little difference to the association between chilli intake and hy-
pertension. Finally, using data from CHNS, Li et al. showed that
preference for hot chilli was inversely associated with insulin
resistance [31]. Insulin resistance is associated with an increased
risk of hypertension [32]. Although the mechanisms are unclear,
activation of TRPV1 channels can mitigate insulin resistance. For
example, dietary capsaicin has been shown to reduce obesity-

Please cite this article in press as: Shi Z, et al., Chilli intake is inversely associated with hypertension among adults, Clinical Nutrition ESPEN
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 Z. Shi et al. / Clinical Nutrition ESPEN xxx (2017) e1ee6
induced insulin resistance in mice [33] through the suppression of
inflammation [34]. Therefore the observed association between
chilli uptake and hypertension could be due to effects on glucose
homeostasis.
Chilli consumption was positively associated with the tradi-
tional dietary pattern but inversely associated with the modern
dietary pattern. However, adjusting for overall dietary patterns did
not change the association between chilli intake and the risk of
hypertension. This suggests that the association between chilli
intake and hypertension is independent of overall dietary patterns.
There are several strengths of this study. Firstly, it is a longitu-
dinal study and 3-day food records in combination with a house-
hold food inventory was used in the assessment of food intake. In
our analysis, we used cumulative mean chilli intake to minimise
measurement error in long-term chilli intake and better assess its
association with hypertension. Although baseline, most recent and
cumulative chilli intake all showed an inverse association between
chilli intake and the risk of hypertension, the effect estimate (HR)
using cumulative average intake showed a stronger inverse asso-
ciation than did those using other two measures. This phenomenon
has been shown previously in other studies, suggesting that the use
of cumulative average intake may reduce measurement error
caused by the variation of dietary intake over time at the individual
level [22]. Secondly, blood pressure was measured using standard
methods by trained health workers during the survey. Thirdly, the
mean follow-up duration is 9 years. Finally, the sample size and the
number of incident hypertension cases provide sufficient statistical
power. The finding is generalizable to adults in China.
A detailed discussion of the study limitations has been pub-
lished elsewhere [18]. In short, the use of a 3-day dietary intake
survey may not adequately characterise long term intake. Chilli
intake was highly correlated with income and region. Although we
have adjusted income, urbanization and dietary pattern in the
multivariable analyses, residual confounding arising from these
factors is still possible. Furthermore, the association between chilli
consumption and hypertension in our study may be under esti-
mated, as a high proportion of chilli consumers by the habitual use
question were classified as non-consumers based on the cumula-
tive intake assessed by multiple 3-day food intake records. How-
ever, the association with chilli intake was strongest for cumulative
chilli intake, but still statistically significant when either baseline
chilli intake or most recent chilli intake was used in the analysis.
In conclusion, chilli intake is inversely associated with incidence
of hypertension among Chinese adults. The association is inde-
pendent of overall dietary pattern but not mediated by body fatness
status.
Statement of authorship
ZS contributed to the conception, analysis, and interpretation of
data; drafting of the report; and have given approval of the final
version for publication. MR, AB and AP contributed to analysis and
interpretation of the data, commented on the report, and have
given approval of the final version for publication.
Conflict of interest
None of the authors have any financial or relationship conflicts
of interest in presenting this paper.
Acknowledgements
This research uses data from China Health and Nutrition Survey
(CHNS). We thank the National Institute for Nutrition and Health,
China Center for Disease Control and Prevention, Carolina
Please cite this article in press as: Shi Z, et al., Chilli intake is inversely associated with hypertension among adults, Clinical Nutrition ESPEN
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e5
Population Center (P2C HD050924, T32 HD007168), the University
of North Carolina at Chapel Hill, the NIH (R01-HD30880, DK056350,
R24 HD050924, and R01-HD38700) and the NIH Fogarty Interna-
tional Center (D43 TW009077, D43 TW007709) for financial sup-
port for the CHNS data collection and analysis files from 1989 to
2015 and future surveys, and the China-Japan Friendship Hospital,
Ministry of Health for support for CHNS 2009, Chinese National
Human Genome Center at Shanghai since 2009, and Beijing
Municipal Center for Disease Prevention and Control since 2011.
Appendix A. Supplementary data
Supplementary data related to this article can be found at
https://doi.org/10.1016/j.clnesp.2017.12.007.
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